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PubMed2005

Atosiban and nifedipin for the treatment of preterm labor.

OBJECTIVE: To perform a comparison between atosiban (oxytocin antagonist) and nifedipin (calcium channel blocker) for acute treatment of preterm labor and their maternal safety. METHODS: A randomized controlled trial study was performed on 80 pregnant women with preterm labor, between 26 and 34 weeks of pregnancy, in Akbar Abadi Teaching Hospital in Tehran, Iran. 40 women (the atosiban group) were compared with another 40 women (the nifedipin group) for the drugs' efficacy in delaying delivery for more than 48 h in order to undergo steroid therapy, and for more than 7 days or more, and also to assess their maternal safety. The duration between the drugs' administration and delivery were compared. The statistical analysis was performed using the Statistical Package for Social Science (SPSS). RESULTS: There was no statistically significant difference between the two groups in the treatment of preterm labor. Atosiban was effective in 82.5% of cases, and nifedipin in 75% of the cases (p=1.000), for delaying delivery for 48 h. Atosiban was effective in 75% of the cases, and nifedipin in 65% of the cases, for delaying delivery for more than 7 days. The maternal side effects in the atosiban group were 17.5%, and in the nifedipin group they were 40%, which had a statistically significant difference (p=0.027). The duration between treatment and delivery was 29.03+/-16.12 days in the atosiban group and 22.85+/-13.9 days in the nifedipin group with no statistically significant difference (p=0.79). CONCLUSION: Atosiban is an effective and safe drug for the acute treatment of preterm labor with minimal side effects, and it can be an option in the treatment of preterm labor, especially in patients with heart disease and multi-fetal pregnancies.

Female↗
PubMed2005

Comparison of continuous background infusion plus demand dose and demand-only parturient-controlled epidural analgesia (PCEA) using ropivacaine combined with sufentanil for labor and delivery.

BACKGROUND: Using ropivacaine combined with sufentanil, we determined the analgesic efficacy of parturient-controlled epidural analgesia (PCEA) with or without (demand-only PCEA) continuous background infusion in reducing labor pain in 66 parturients. METHODS: After placement of the epidural catheter and administration of an initial bolus containing ropivacaine 16 mg and sufentanil 10 microg, parturients were prospectively randomized into two groups. The PCEA solution consisted of ropivacaine 0.16% plus sufentanil 0.5 microg/mL. Parturients with PCEA plus continuous background infusion received 4 mL/h plus an hourly maximum of three 4-mL boluses on demand (lock-out time 20 min); parturients with demand-only PCEA received an hourly maximum of four 4-mL boluses (lock-out time 15 min) of anesthetic solution. Pain scores (VAS 0-100 mm), drug doses administered, duration of labor, sensory and motor epidural block characteristics, maternal satisfaction, neonatal outcome and adverse events were determined. RESULTS: Both regimens provided excellent parturients' satisfaction and pain relief. However, periods of VAS scores>40 mm during all stages of labor were significantly more frequent in parturients receiving demand-only PCEA (22.4%) compared to parturients receiving PCEA plus continuous background infusion (7.5%, P=0.0011). Drug doses administered, duration of PCEA, labor and delivery, epidural block characteristics, neonatal outcome and adverse events did not differ between groups. CONCLUSION: Under the conditions of the study, PCEA plus continuous background infusion was more effective than demand-only PCEA in treating labor pain without increasing consumption of anesthetic solution.

Adult↗
PubMed2005

Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia.

BACKGROUND: Several studies have been performed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus. We aimed to compare the efficacy and side effects of epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl at low concentrations. METHOD: Forty ASA I-II parturients' were included in this prospective, double-blind, trial and randomized to receive either bupivacaine or ropivacaine for labor analgesia. Analgesia was initiated with 8 mL of 0.125% solution plus fentanyl 50 microg and maintained with a continuous infusion of 0.0625% solution with fentanyl 2 microg/mL. RESULTS: There were no differences in pain scores, total dose of local anesthetics used, sensory or motor blockade, labor duration, mode of delivery, side effects, patient satisfaction, or neonatal outcome between the two local anesthetics at these dosages, but at the end of the second stage and delivery, adequate analgesia quality could not be ensured. CONCLUSION: We found no major advantage of continuous epidural infusion of ropivacaine 0.0625% plus fentanyl 2 microg/mL over bupivacaine 0.0625% plus fentanyl 2 microg/mL for labor analgesia. We believe that different methods or dosages may be tried in order to improve comfort at the second stage of labor and the delivery.

Adult↗
PubMedDate not supplied

Supporting women in labor: analysis of different types of caregivers.

Continuous labor support offers multiple benefits for mothers and infants. The type of caregiver that is the best support person in labor has not been identified. A critical review of the English language literature was conducted to describe the current state of knowledge on different types of labor support persons. Randomized trials and other published reports were identified from relevant databases and hand searches. Studies were reviewed and assessed by using a structured format. Eight randomized trials met the selection criteria for inclusion in this analysis. These trials investigated untrained and trained lay women, female relatives, nurses, lay midwives, and student lay midwives as labor support persons. Support by untrained lay women starting in early labor and continuing into the postpartum period demonstrates the most consistent beneficial effect on childbirth outcomes. However, more randomized controlled trials are warranted before firm conclusions may be drawn.

Caregivers↗
PubMed2005

Spatial and temporal expression of the myometrial mitogen-activated protein kinases p38 and ERK1/2 in the human uterus during pregnancy and labor.

OBJECTIVE: We have recently identified a novel putative spliced variant of the activating transcription factor 2 (ATF2) in the human myometrium during pregnancy and labor. This protein, termed ATF2-sm like full-length ATF2, acts as a potent transactivator of cyclic adenosine monophosphate response element (CRE)-containing promoter reporter genes. Similarly, employing microarray gene profiling in myometrial cells, we have shown ATF2-sm to affect the expression of several specific myometrial genes associated with regulating uterine activity during pregnancy and labor. At some point after conception this transcription factor becomes spatially expressed within the body of the uterus, with significantly higher levels detected in the upper (corpus) compared to the lower uterine segment. Because ATF2 species are the primary substrate for phosphorylation by the mitogen-activated protein kinases (MAPKs) p38 and ERK1/2, the purpose of the current investigation was to define the expression levels of these kinases in upper and lower segment myometrium during pregnancy and labor to see if they also correlated with expression of ATF2-sm. METHODS: Paired myometrial samples were collected from the upper (corpus) and lower uterine segments from term nonlaboring and spontaneously laboring women undergoing elective and emergency cesarean deliveries, respectively. Non-pregnant myometrial samples were collected from premenopausal women having hysterectomies for benign gynecologic disorders. The MAPKs p38 and ERK1/2 present in individual myometrial homogenates were resolved using sodium dodecyl sulfate polacrylamide gel electropheresis (SDS-PAGE) with subsequent Western blotting with specific antibodies and scanning densitometry. Expression of the individual MAPKs in myometrial tissues was confirmed in situ using immunohistochemistry. RESULTS: In non-pregnant tissues, p38 and ERK1/2 expression was uniform throughout the uterus. In term pregnant nonlaboring and spontaneously laboring samples expression of p38 and ERK1 was significantly elevated in the upper uterine segment compared to the lower segment, respectively. In contrast, there was no difference in ERK2 expression. CONCLUSION: The data from this study indicate that both p38 and ERK1 are spatially regulated in different uterine regions during pregnancy/labor and suggest that they may be involved in regulating the activity of ATF2 isoforms and their subsequent effects on myometrial function.

Activating Transcription Factor 2↗
PubMed2005

Differential expression of protein kinase A, AKAP79, and PP2B in pregnant human myometrial membranes prior to and during labor.

OBJECTIVE: We have previously shown that the association of protein kinase A (PKA) with purified myometrial plasma membrane declined at the end of pregnancy in the rat. This study was designed to determine if a similar decline in PKA occurred in pregnant human myometrium. METHODS: Myometrial plasma membranes were isolated from lower uterine segment tissues from not-in-labor (NIL) and in-labor (IL) patients undergoing cesarean delivery. Membrane proteins were subjected to Western blot analysis to detect PKA-catalytic (PKA-cat) and PKA-regulatory (PKA-reg) subunits, the PKA binding protein A-kinase anchoring protein 79 (AKAP79), protein phosphatase 2B (PP2B), and Galphaq, a guanosine triphosphate (GTP)-binding protein. Protein levels were expressed relative to caveolin-1, which was invariant between the two groups. RESULTS: The amount of PKA-cat, PKA-reg, AKAP79, and PP2B in plasma membranes from myometrium of women in early labor decreased significantly compared with that in tissues from women not in labor. In contrast, Galphaq did not change. All proteins were localized to myometrial smooth muscle cells by immunohistochemistry. CONCLUSIONS: Expression of PKA, PP2B, and AKAP79 is consistent with the presence of a functional AKAP-mediated signaling complex in pregnant human myometrial membranes. A small but significant decrease in PKA, AKAP79, and PP2B in myometrial tissues from women in labor may contribute to a decrease in negative feedback on and enhancement of contractant signals at term.

A Kinase Anchor Proteins↗
PubMed2000

Does chondroitin sulfate defend the human uterine cervix against ripening in threatened premature labor?

OBJECTIVE: This study was undertaken to investigate changes in chondroitin sulfate levels in the cervix and the physiologic role of chondroitin sulfate isomers in the process of cervical ripening. STUDY DESIGN: Uterine cervical mucus samples were obtained from 57 women (7 nonpregnant women, 19 at preterm gestation, 9 at term gestation, 16 during the first stage of term labor, and 6 with threatened premature labor). Chondroitin sulfate isomer (chondroitin 0-sulfate, 4-sulfate, and 6-sulfate) concentrations in cervical mucus were measured by high-performance liquid chromatography. The effect of exogenous chondroitin sulfate on hyaluronidase activity in cervical mucus was evaluated by gel permeation chromatography of fluorolabeled hyaluronic acid. RESULTS: Chondroitin sulfate concentrations in cervical mucus were increased significantly (P <. 05) in the threatened premature labor group compared with the preterm and term groups. However, the same finding was not observed in the first stage of term labor. Exogenous chondroitin sulfate inhibited hyaluronidase activity in mucus. CONCLUSION: Chondroitin sulfate may defend against cervical ripening in threatened premature labor.

Cervical Ripening↗
PubMed2003

Gastroschisis: the effect of labor and ruptured membranes on neonatal outcome.

OBJECTIVES: The purpose of this study was to examine the relationship between labor and ruptured membranes on the neonatal outcome of infants with gastroschisis. STUDY DESIGN: We reviewed the outcomes of 60 neonates who were prenatally diagnosed with gastroschisis and who were delivered at the University of North Carolina Hospitals between June 1989 and April 1999. RESULTS: The mean gestational age at delivery was 36 weeks. Four infants (7%) died in the neonatal period, and 19 infants (32%) had a major morbidity. No significant differences appeared in any of the neonatal outcomes when they were stratified by the presence or absence of labor and presence or absence of ruptured membranes. After being controlled for confounding variables, the risk of neonatal death or major neonatal morbidity because of exposure to either labor or ruptured membranes was no different than the risks caused by no labor or intact membranes, respectively. CONCLUSION: Labor and ruptured membranes do not appear to be associated with increased neonatal morbidity or mortality rates in neonates with gastroschisis.

Adolescent↗
PubMed1992

Obstetric parameters affecting success in a trial of labor: designation of a scoring system.

OBJECTIVES: We sought to characterize risk factors in patients undergoing trial of labor after previous cesarean section and to determine whether a subset of patients at high risk of having an unsuccessful trial of labor consequently suffer greater morbidity. STUDY DESIGN: A 13-month chart review analyzed 264 labors with documented transverse lower uterine segment scars. Historic and physical examination variables were recorded, and a scoring system was constructed to evaluate successful vaginal delivery after cesarean. RESULTS: Successful vaginal delivery occurred in 192 patients, resulting in a rate of vaginal birth after cesarean of 72.7%. Four variables significantly lower the rate of vaginal birth after cesarean. Of patients scoring 0 (no variables present), 91.5% were successfully delivered vaginally. Scores of 1, 2, and 3 to 4 were associated with the success of vaginal birth after cesarean in 73.9%, 66.7%, and 46.1% of patients, respectively. A score of 3 to 4 did not increase maternal or fetal morbidity in trial-of-labor patients. CONCLUSION: We constructed a scoring system to evaluate the success of vaginal birth after cesarean. Trial of labor in the subset of patients with the lowest success rate does not increase morbidity.

Cesarean Section↗
PubMed1993

Automated blood pressure measurements in laboring women: are they reliable?

OBJECTIVE: In laboring women a consistent difference has become evident between measurements obtained with an automated blood pressure device and those obtained with the auscultatory method. A prospective study was designed to assess the concordance of these two methods. STUDY DESIGN: Three sets of brachial blood pressure measurements were made by both oscillatory and auscultatory techniques in 30 women in labor, 20 term pregnant women not in labor, and 20 nonpregnant volunteers. RESULTS: In the nonlaboring women and the nonpregnant controls there was satisfactory agreement between the results of the two methods of measurement. In the parturients systolic pressures were consistently and significantly higher and diastolic pressures consistently and significantly lower with the oscillatory compared with the auscultatory method, but mean arterial pressures were not different. CONCLUSION: In laboring women there is a discrepancy between systolic and diastolic pressures obtained by the auscultatory versus the oscillatory method of measurement, although mean pressures are not significantly different. We suggest that during labor the diagnoses of hypertension and hypotension be based on the mean rather than the systolic or diastolic pressure.

Auscultation↗
PubMed1983

The course of labor in term patients with chorioamnionitis.

Labor records and internal fetal monitor tracings of 65 patients with uncomplicated term pregnancies who entered labor spontaneously and then developed chorioamnionitis were reviewed. Eighty-eight percent of patients were nulliparous. Seventy-five percent had abnormal labor, characterized by decreased uterine contractility, and 34% required cesarean delivery because of failure to progress in labor. The most common fetal heart rate abnormalities were diminished or absent variability (77%) and tachycardia (67%); 15% of the tracings had a sinusoidal pattern. Despite the high prevalence of abnormal fetal heart rate tracings, only one infant had a 5-minute Apgar score less than 7. It is concluded that chorioamnionitis has an inhibitory effect on labor. Compared to uninfected women, certain infected patients appear to require higher doses of oxytocin and greater uterine activity to effect a given change in cervical dilation.

Adolescent↗
PubMed1984

Plasma beta-endorphin concentrations prior to and during pregnancy, in labor, and after delivery.

Beta-Endorphin was measured by radioimmunoassay in peripheral plasma of nonpregnant women (58 +/- 2.4 pg/ml, n = 17, mean +/- SE), during the first trimester (47 +/- 2.4 pg/ml, n = 11), the second trimester (33 +/- 1.9, n = 11), and the third trimester (49 +/- 2.7 pg/ml, n = 10) of pregnancy, during early (202 +/- 32 pg/ml, n = 12) and advanced labor (389 +/- 78 pg/ml, n = 10), and 30 to 60 minutes post partum (177 +/- 22 pg/ml, n = 12). Mean plasma levels of beta-endorphin were significantly lower in each trimester of gestation than the levels in nonpregnant control subjects. During labor and the early postpartum period, maternal plasma levels of beta-endorphin were significantly elevated. Furthermore, peripheral plasma levels of beta-endorphin during labor fell from 189 +/- 31 to 97.6 +/- 12 pg/ml (n = 13, p = 0.015) in response to epidural anesthesia, as compared to peripheral plasma concentrations of beta-endorphin of 223 +/- 71 and 193 +/- 47 pg/ml prior to and after injection of saline solution into epidural catheters, respectively, in 10 control subjects. Mean plasma levels of beta-endorphin in patients immediately prior to elective repeat cesarean section who were not in labor (151 +/- 23 pg/ml, n = 15) were significantly higher (p less than 0.005) than the levels in third-trimester control subjects. These data indicate that the pain associated with labor and the psychological stress of anticipating an operation are potent stimuli for the pituitary release of beta-endorphin.

Anesthesia, Epidural↗
PubMed1985

Maternal and fetal beta-endorphin release in response to the stress of labor and delivery.

In order to clarify the stress effect of labor on maternal and neonatal plasma levels of beta-endorphin, we measured this peptide in samples taken from 40 pregnant patients and their neonates at the time of normal vaginal delivery (n = 15), and at cesarean section performed either in early labor (n = 13) or prior to labor (n = 12). The mean (+/- SE) maternal plasma concentration of beta-endorphin in the vaginal delivery group was 40.3 +/- 5.6 fmol/ml, which was significantly higher than that in their neonates (21.3 +/- 2.9 fmol/ml). In contrast, maternal levels of beta-endorphin in the cesarean section groups (8.2 +/- 1.2 and 8.5 +/- fmol/ml) were significantly lower than those in their neonates (23.3 +/- 5.6 and 15.6 +/- 2.8 fmol/ml). Concentrations of beta-endorphin in mothers delivered vaginally were also significantly higher than those in mothers delivered by cesarean section. However, there was no difference in mean cord levels of beta-endorphin among the three groups. These findings indicate that neither the presence or absence of labor affects fetal plasma beta-endorphin secretion and the stress of labor and delivery produces a marked increase in maternal release of beta-endorphin.

Cesarean Section↗
PubMed1987

A prospective randomized study of the aggressive management of early labor.

The aggressive management of early labor has been suggested as a means to lower the cesarean section rate for dystocia. The aim of our study was to prospectively evaluate a protocol of early intervention in primigravid women with infrequent uterine contractions during early labor in relation to the course of labor, the cesarean section rate, and the perinatal morbidity. In our population the active management of labor did not alter the mode of delivery or the perinatal outcome. Furthermore, the course and duration of labor were not significantly different between the management and control groups.

Adult↗
PubMed1997

Induction of labor with use of a Foley catheter and extraamniotic corticosteroids.

OBJECTIVE: Our purpose was to examine the hypothesis that corticosteroids, when administered extraamniotically, can enhance the labor process and reduce the induction-to-delivery interval. STUDY DESIGN: A double-blind, randomized study was conducted on 98 women with a gestational age of 36 to 42 weeks, an unfavorable cervix, and medical indications for delivery, who were assigned to receive either 20 mg of dexamethasone in saline solution (study group, n = 50) or saline solution only (control group, n = 48) administered extraamniotically through an intracervical inflated Foley balloon catheter. The net effect of steroids was assessed with use of multivariant logistic regression analysis. RESULTS: The mean time intervals between induction of labor to the active phase and between induction of labor to delivery were significantly shorter in the study group compared with those of the control group (7.8 +/- 3.1 hours vs 9.9 +/- 3.9 hours, p < 0.03, 11.9 +/- 3.0 hours vs 14.5 +/- 4.8 hours, p < 0.01, respectively). Those not receiving steroids were at a 3.2 higher risk of having a longer time interval of induction to delivery (95% confidence interval 1.1 to 9.5). The general success rate in achieving vaginal delivery was, however, similar between the groups. CONCLUSIONS: Induction of labor with use of an intracervical Foley balloon catheter and extraamniotic corticosteroids reduces the time interval from induction of labor to delivery. This may indicate a possible role for corticosteroids in the parturition process.

Adult↗
PubMed1998

Is the attenuation of beta-adrenergic agonist efficacy during labor caused by elevated prostaglandin E levels?

OBJECTIVE: Our purpose was to investigate whether attenuation of beta-adrenergic agonist efficacy during labor is due to elevated prostaglandin E levels. STUDY DESIGN: beta-Receptor function (response to beta-agonist or forskolin) was tested in mononuclear leukocytes collected from women at term before or during labor. beta-Receptor function was also tested in mononuclear leukocytes of nonlaboring patients after in vitro incubation with oxytocin (1 micromol/L), prostaglandin E2 (10 micromol/L), prostaglandin F2alpha (10 micromol/L), or buffer alone. RESULTS: Mononuclear leukocytes from women in active labor exhibited a significant attenuation of beta-adrenergic receptor function as a result of reduced adenylyl cyclase activity. This effect could be induced in mononuclear leukocytes from nonlaboring women by preincubation with prostaglandin E but not oxytocin or prostaglandin F. CONCLUSIONS: Prostaglandin E induces heterologous desensitization of the beta-adrenergic receptor system in mononuclear leukocytes, comparable to that seen during labor. We speculate that during labor the elevated levels of prostaglandin E may induce similar effects on the myometrium, thereby decreasing the efficacy of beta-agonists as tocolytics.

Adenylyl Cyclases↗
PubMed1998

Is there an association between water baths during labor and the development of chorioamnionitis or endometritis?

OBJECTIVE: Our purpose was to determine whether water baths during labor are associated with the development of chorioamnionitis or endometritis. STUDY DESIGN: One hundred ten cases of chorioamnionitis or endometritis and 97 controls were identified among singleton term gestations from the University of California at San Francisco perinatal database. Medical record review and patient interviews provided information on membrane rupture, history of bathing during labor, and relaxation and pain relief perceived by patients who experienced water bathing during labor. RESULTS: There was no statistically significant association between water baths during labor and the occurrence of chorioamnionitis or endometritis (odds ratio 0.93 [95% confidence interval 0.53 to 1.63]). CONCLUSIONS: Water baths during labor are not associated with chorioamnionitis or endometritis.

Adult↗
PubMed1999

A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare orally administered with vaginally administered misoprostol for cervical ripening and labor induction. MATERIAL AND METHODS: Two hundred twenty subjects with medical or obstetric indications for labor induction and undilated, uneffaced cervices were randomly assigned to receive orally administered or vaginally administered misoprostol. Fifty micrograms of oral misoprostol or 25 microgram of vaginal misoprostol was given every 4 hours. If cervical ripening (Bishop score of >/=8 or cervical dilatation of >/=3) or active labor did not occur, repeated doses were given to a maximum of 6 doses or 24 hours. Thereafter, oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum of 22 mU/min. RESULTS: Of the 220 subjects evaluated, 110 received orally administered misoprostol and 110 received vaginally administered misoprostol. Fewer subjects who received the oral preparation (34/110, 30.9%) were delivered vaginally within 24 hours of initiation of induction, in comparison with those who received the vaginal preparation (52/110, 47.3%) (P =.01). The average interval from start of induction to vaginal delivery was nearly 6 hours longer in the oral treatment group (mean and SD 1737.9 +/- 845.7 minutes) than in the vaginal treatment group (mean and SD 1393.2 +/- 767.9) (P =.005, log-transformed data). Orally treated patients required significantly more doses than vaginally treated patients (orally administered doses: mean and SD 3.3 +/- 1.7; vaginally administered doses: mean and SD 2.3 +/- 1.2) (P <.0001). Oxytocin administration was necessary in 83 (75.4%) of 110 orally treated subjects and in 65 (59.1%) of 110 vaginally treated subjects (P =.01, relative risk 1. 28, 95% confidence interval 1.06-1.54). Vaginal delivery occurred in 95 (86.4%) orally treated subjects and in 85 (77.3%) vaginally treated subjects (P =.08, relative risk 1.12, 95% confidence interval 0.99-1.27), with the remainder undergoing cesarean delivery. There was no difference in the incidence of uterine contractile abnormalities (tachysystole, hypertonus, or hyperstimulation), intrapartum complications, or neonatal outcomes between the 2 groups. CONCLUSIONS: Oral administration of 50-microgram doses of misoprostol appears less effective than vaginal administration of 25-microgram doses of misoprostol for cervical ripening and labor induction. Further investigation is needed to determine whether orally administered misoprostol should be used for cervical ripening and labor induction.

Administration, Intravaginal↗